Medical Secrecy To End

January 13, 2001|By STACEY SINGER Health Writer

The state commission charged with tackling medicine's high rate of errors voted Friday to form a new office charged with gathering and disseminating information about medical mistakes to health professionals and the public.

Dr. Arthur Palamara, a vascular surgeon from Hollywood, said he fought for the proposal after the Sun-Sentinel detailed a similar idea in an investigative series published in October titled, "Death in Vain: How Medicine Repeats its Mistakes."

The series found the greatest barrier to improving patient safety is the culture of secrecy, fear and blame that surrounds medical error. It disclosed how the medical industry has spent hundreds of thousands of dollars lobbying for measures to keep the information out of the public eye. The series also described a few health professionals who have saved lives by abandoning that culture and sharing what they knew about medical errors.

Palamara told his fellow members of the Commission on Excellence in Health Care, meeting in Tallahassee, that the only way health care will truly improve is through the medical industry sharing data on mistakes and their remedies.

"It speaks to the heart of what we are doing here as a committee, to improving patient care in the state of Florida," said Palamara, who represented the Florida Medical Society on the commission. "We're all real happy that we got something meaningful accomplished."

The commission's final report calls for creating a new body, called the Interagency Council on Patient Safety and Excellence. It would be run by the Agency for Health Care Administration and the Florida Department of Health.

That body would operate much as NASA does with the Aviation Safety Reporting System.

NASA encourages anyone involved with flight to send in a report of a near-miss or mechanical problem. Experts there analyze the problems and then disseminate regular safety updates.

People who report the problems are guaranteed confidentiality and assured that they will not suffer any repercussions. The reporting system is credited with making flight one of the safest forms of transportation in the United States.

That reporting system was founded and managed by a pilot and physician named Charles Billings. Palamara said he quoted from an article by Billings in advocating the design of the agency: "It has to be voluntary and nonpunitive" to win the confidence of health professionals, whose jobs can be threatened for disclosing hospital secrets, he said.

The council's reports on mistakes would become public after experts investigated and analyzed them. The names of hospitals and health professionals would be removed, and the reports could not be used in any malpractice action. The goal would purely be to improve care, Palamara said.

Lena Juarez, a Tallahassee lobbyist who was appointed a consumer advocate on the commission, said her subcommittee favored making the proposed Council on Patient Safety independent from any state agency, but that suggestion failed.

The Department of Health licenses health professionals, and the Agency for Health Care Administration regulates hospitals, meaning they can punish health providers who make errors, something the commission agreed had a chilling effect on incident reporting. But creating an independent agency would have required legislative approval, Juarez said.

Making the council part of existing agencies means it can be launched immediately. Agency heads can draft administrative rules and publish them.

Grants are available to pay for the project, but the agencies could also ask for funding in their budget request to the Legislature.

The key to the new body's success will be protecting the confidentiality of people who report incidents, she said.

"I wish we didn't have to compromise," she said. "But we got the job done."

The 40 members of the commission were hand-picked by the Legislature last spring to represent every special interest in health care. Getting them to set aside their associations' political agendas was difficult, Palamara said.

The Florida Hospital Association's representative, Suzie White, had advocated creating an incentive program for hospitals that adopted the best safety practices. That proposal became part of the Commission on Excellence's final recommendation as well.

The final report also calls for creating a new office to conduct research and educate the public on medical safety. "It just shows that when you push the limit you get things done," Juarez said.

Stacey Singer can be reached at ssinger@sun-sentinel.com or 954-356-4209.